Digital Competencies and Training Approaches to Enhance the Capacity of Practitioners to Support the Digital Transformation of Public Health: Rapid Review of Current Recommendations

Introduction

The context for public health training, practice, and research is rapidly evolving due to the widespread development and deployment of digital technologies in the field. The COVID-19 pandemic highlighted the importance of digital technologies in sustaining public health systems, especially in crises, and emphasized gaps in the workforce’s capacity to deploy digital technologies while upholding ethical, social justice, and health equity principles that are fundamental to public health [1-3]. To facilitate essential public health functions, digital technologies are increasingly being used, including artificial intelligence (AI), machine learning (ML), and digital dashboards, to enable real-time disease surveillance and predict population and public health outcomes [4-7]. Social media and other health apps and websites have enabled people-centered public health promotion and protection [4-7]. These use cases demonstrate potential benefits of digital technologies to ensure precise, proactive, and efficient public health services.

The public health workforce continues to encounter human resource capacity challenges regarding competencies to appropriately respond to the need for widespread integration of digital technologies within public health workstreams [8]. Growing public expectations for responsive and detailed public health information, influenced by experiences of digital transformation in sectors like finance, commerce, education, and health, generally further underscore the need for commensurate digital transformations of public health [3,9]. Digital transformation has been defined as a cultural shift involving the pervasive integration of digital technologies across organizational processes based on user needs [9]. The acceleration of digital transformation in society during the COVID-19 pandemic further accentuated the role of digital technologies as a “superdeterminant” of health and health disparities [10-13]. The public health workforce must develop new competencies to appropriately leverage digital technologies for public health functions, including monitoring and addressing the health implications arising from digital transformation in society [14]. While this transformation affects both public health and clinical medicine, the discourse around digital health is largely focused on clinical uses of digital technologies or virtual care (eg, telemedicine or remote patient monitoring), often leaving public health perspectives unattended. Despite an overlap between clinical medicine and public health, we need a distinct understanding of how public health—the organized effort of society to keep people healthy and prevent injury, illness, and premature death—might be impacted through digital technologies and what digital competencies are required to optimize public health outcomes [9,15].

In Canada, the public health core competency framework was last published in 2007 by the Public Health Agency of Canada (PHAC) and does not reflect current digital contexts [3,8,16]. It also does not adequately consider the prominent role digital technologies play in contemporary public health. In other jurisdictions, public health training institutions have considered integrating more advanced training on digital technologies within their public health curricula. In 2020, the World Health Organization and Association of Schools of Public Health in the European Regions updated their competency framework, emphasizing competencies for applying digital technologies for managing, analyzing, and storing health information and communicating health messages through modern (digital) media [17]. In the United States, the Council on Linkages between Academia and Public Health Practice updated its core competencies in 2021, maintaining competency statements like “applies public health informatics in using data, information and knowledge” in its data analytics and assessment domain, while adding similar statements related to social media use [18]. The existing frameworks do not describe disciplinary perspectives that can facilitate these competencies. Our previous work suggests interdisciplinary perspectives (including engineering, computer science, health information, and behavioral sciences) are crucial for these competencies [1,8], but the scope and characteristics of these interdisciplinary collaborations remain unclear.

This review aimed to contribute to the advancement of public health curricula, especially in Canada, by identifying practice competency and training recommendations to enhance public health practitioners’ capacity to support the digital transformation of public health. Here, we refer to practice competencies as the essential knowledge, skills, and attitudes necessary for the practice of public health that transcend disciplines and specific programs and form the baseline requirements to fulfill public health functions [16]. We use the term “public health practitioners” to refer to a broad range of professionals who work in various areas of public health and serve to improve health outcomes at a population level, as compared to the individual level (these professionals comprise the public health workforce). They include, but are not limited to, public health nurses and physicians, epidemiologists, health promotion specialists, and public health managers [19]. We also aimed to identify disciplinary perspectives relevant to implementing practice competency and training recommendations and the scope of interdisciplinary partnerships that may be required.

Methods

Overview

We conducted our rapid review following the Cochrane rapid review recommendations [20] and World Health Organization guidelines [21]. Our rapid review protocol was registered on PROSPERO (CRD42022384474) and published on the Open Science Framework [22]. This review is the first phase of a multiphase study aiming to contribute recommendations for digital public health workforce competencies in Canada [23]. Given the exploratory nature of our research, our reporting aligned best with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) (Multimedia Appendix 1 [24]). Our focused research questions were as follows: (1) What public health practice competencies are recommended to facilitate the integration of digital technologies in public health functions? (2) What training approaches may best facilitate the learning and teaching of identified practice competency recommendations? and (3) What disciplines/disciplinary perspectives should be considered to facilitate identified practice competencies and training recommendations?

Data Sources

We searched Ovid MEDLINE, Ovid Embase, Web of Science, and ERIC (Education Resources Information Center) for peer-reviewed articles exploring recommendations for practice competencies and training related to digital technologies for public health. In consultation with a University of British Columbia librarian, we created a search strategy (Table 1) with terms related to public health (defined as the organized effort of society to keep people healthy and prevent injury, illness, and premature death through a combination of programs, services and policies that protect and promote the health of all) [15]; digital health (the field of knowledge and practice associated with the use of digital technologies to improve health) [25]; and practice competencies and training (essential knowledge, skills, and attitudes necessary for the practice of public health that transcend disciplines and specific programs and form the baseline requirements to fulfill public health functions) [16]. We also searched various public health agency websites (Multimedia Appendix 2) and preprint servers such as Europe PubMed Central (PMC), which indexes preprints, including those from arXiv.org, for gray literature. We conducted a supplementary search on Google Scholar and Google using a simplified version of our original search and explored the first 10 pages of returned results, as is commonly done in similar reviews [26,27]. Finally, we used CitationChaser to perform automated forward and backward citation searches for articles included in our study [28]. Our search was limited to articles published in English between January 2010 and December 13, 2022 (the date of our search). All relevant search returns were exported to Covidence (Veritas Health Innovation) for citation management and review.

Screening and Selection Procedure

Our inclusion and exclusion criteria were informed by our adaptation of the Joanna Briggs Institute PCC (population, concept, and context) research question framework (Textbox 1) [29]. We included publications describing practice competencies and training recommendations related to the use of digital technologies for population and public health among public health students, public health informaticians and analysts, public health physicians, practitioners, researchers, and decision-makers [30]. We included reviews, commentaries, position statements, policy guidelines, and primary research studies exploring our concept of interest. We excluded publications with a solely clinical perspective.

We conducted our screening and selection in 2 phases after automatic deduplication on Covidence. For feasibility and in line with Cochrane rapid review recommendations, 2 reviewers (SR and II) independently screened 25% of the titles and abstracts using the inclusion and exclusion criteria, regularly meeting to discuss discrepancies and achieve consensus. The remaining titles and abstracts were screened by 1 reviewer (SR). In the second phase, both reviewers (SR and II) assessed the eligibility of all included full texts, meeting to discuss discrepancies where appropriate. A summary of the selection process is described in Figure 1.

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Empirical Critical Appraisal of Included Studies

Considering the mixed nature of the included publications, we only conducted a risk of bias assessment of the primary research studies included in this study, using the Mixed Methods Appraisal Tool (version 2018) (Multimedia Appendix 3 [31-43]).

Data Extraction and Analyses

We extracted data from the included publications using pretested data extraction forms in Covidence (Multimedia Appendix 4) [15]. These forms were tested using the first 2 included publications, with discussions between reviewers to clarify discrepancies in interpretation. We extracted bibliographic information including authors’ names, year of publication, title, journal, country and continent of first author, publication type, and study aims or objectives (where applicable). We also extracted competency recommendations and mapped them onto the existing competency categories of the 2007 PHAC framework [32-43] for core competencies for public health and created new categories for recommendations not fitting into existing categories [16]. For competency recommendations applicable to more than 1 category, we mapped the recommendations into multiple categories. We further categorized the competencies as those specific to digital technologies, those not specific but relevant to digital technologies, and basic literacy competencies specific to digital technologies. Finally, we extracted descriptions and recommendations about training approaches, disciplines involved in facilitating training, and public health domains where competency recommendations were most applicable [15]. All these were summarized using a narrative synthesis.

Results

Characteristics of Included Publications

Table 2 describes the 12 publications included in this review, all by authors in North America [32-43]; 11 of 12 were written by first authors in the United States [32,34-43], 5 of 12 were published between 2010 and 2015 [34,37,38,40,43] and 6 of 12 were commentaries or perspectives [33,35,36,40-42]. Of these, the 4 studies included in the quality appraisal showed variable quality, with 3 being observational studies (Multimedia Appendix 3).

Domains of Public Health Relevant to Digital Technologies

Practice competencies were most described in relation to public health research (n=10 articles) [32-40,42,43], epidemiology and surveillance (n=9 articles) [32-36,38,39,42,43], risk assessment (n=3 articles) [32,33,38], and health promotion (n=3 articles) [38,41,43].

Practice Competency Recommendations Related to Digital Technologies

We identified competency recommendations regarding the implementation of digital technologies across all 7 competency categories in the PHAC framework (Table 3). We also identified an additional category of competencies for managing digital data, data systems management, and governance. Here, we highlight competency statements that are not specific to, but relevant to, digital technologies in public health, including using multiple data sources (including digital data) to answer public health questions (public health sciences), understanding methods for data linkage (assessment and analyses), ensuring inter- and transdisciplinary methods for designing and implementing studies and research (partnerships, collaboration, and advocacy), and developing an entrepreneurial orientation to innovation and risk-taking to address public health concerns (leadership) [16]. Others include defining audiences for developing and disseminating tailored public health information based on trusted formats and information sources (communication) and developing tools to protect the privacy of individuals and communities involved in public health programs (data and data systems management and governance). These competency statements serve as an overview of what was identified from the literature and can serve as a guide in determining important considerations in updating public health curricula.

Regarding competencies specific to digital technologies in public health, the most cited competency statements related to developing and ethically applying modern research methods requiring big data (eg, omics and computational biology in public health sciences) [35] and tools (eg, computer programming and geographic information systems) [32]; using, protecting, and interpreting large linked data sets from multiple sources using a blend of traditional and modern analytic techniques (assessment and analyses) [34,35,37]; communicating with the public using tools like social media for public health (communications) [36,41]; and establishing frameworks for evaluating health information systems and communication efforts using tools like social media and web analytics (communication, policy and program planning, implementation, and evaluation) [41]. Additional competencies in this category include supporting the development of IT systems using systems thinking (leadership) [37,39], applying procedures and technical means to ensure the integrity and protection of confidential information in electronic files and computer systems, and developing interoperable data systems (data and data systems management and governance) [34,35,38].

One recommendation was identified for basic literacy competencies specific to digital technologies regarding effectively communicating with teams through email, word processing, spreadsheets, and presentation software (communication) [32].

Training Approaches

The 2 main categories of training approaches identified included recommendations for adapted degree-awarding programs and ongoing training or professional development. Most of the recommendations concerned adapting degree-awarding public health programs. These included expanded public health core training on digital technologies as introductory training with elective specialization [33-36,38,40,43], practice-informed training embedded in real-world contexts and organizations [33,41,42], specialized master’s- and doctoral-level training in specific digital technology–related fields like data science and population and public health informatics [33,34,39], integrated master’s in public health and public health informatics training programs, one-on-one mentorship programs in practice and research settings [34], and engaging interdisciplinary teams to design public health training for digital technologies [36]. The second category of training recommendations related to ongoing training and professional development in the context of continuing education [32,34,35,38,39]. These recommendations mainly included competency-based learning on digital technologies through short courses, workshops, and certification programs in partnerships with academic institutions [32,34,35] and online training targeting specific global workforce deficiencies [38,39].

Disciplines Relevant in Implementing Digital Competencies and Training Programs for the Digital Transformation of Public Health

Disciplines identified as relevant to digital public health training include public health [32-36,41,43], public health informatics [32,34,35,37-40,42], computer science [33-35,40,42], data science [33-35], mathematics [33,40], statistics/biostatistics [33,40,43], health communication [34-36,43], sociology/social sciences [34,35,40], business [36], economics [36], management sciences [36,40,42], and information sciences [36,42,43].

Discussion

Principal Findings

In this rapid review, we identified 12 publications describing 45 unique recommendations for digital practice competencies across 8 competency categories described as essential to support the public health workforce in the digital transformation of public health, especially from a Canadian perspective. Recommendations cut across all competency categories of the 2007 public health core competency framework in Canada. These recommendations included basic digital literacy competencies (general digital skills required for carrying out public health operations), competencies specific to digital technologies (ie, competencies relevant to specific public health functions that leverage digital technologies), and competencies not specific to, but relevant to digital technologies (ie, broad competencies not specific to, but accentuated by using digital technologies in public health). We also identified recommendations related to a new competency category that we called “data and data systems management and governance” related to the management and use of new digital data relevant for public health functions.

Interestingly, our study identified gaps in the current literature. Despite demonstrable awareness of digital competency gaps for public health, substantive competency recommendations were generally lacking, as evident with only 12 articles included in this study. The digital competency discourse was also dominated by “public health informatics” and “data science,” as 8 of the 12 articles were focused on “public health informatics.” While partly attributable to the subsuming of digital public health into the broader discourse on digital health, it demonstrates the need for research in this space. Recent “digital health” reviews have identified diverse competencies like understanding concepts for AI and ML more specifically in health, modern data infrastructure, pros and cons of telehealth, applications of wearable sensors, and skills for managing health services in the context of digital transformation [44,45]. Researchers suggest that similar competencies focused on “digital public health” are necessary to ensure that the digital transformation of public health is not overlooked, as it is a distinct but related field to digital health [14,46].

This study also identified training recommendations, including adapting degree-awarding programs and ongoing professional development to integrate interdisciplinary approaches to ensure broad competencies for digital technologies with options for specialized competency-based training where necessary. These findings parallel those of a scoping review of digital health competencies for medical school education that suggested recognition of interdisciplinary collaboration in digital health is an important attitude to be considered in contemporary training [36,44]. As identified in our study, such disciplines could include public health (including epidemiology and health promotion), health informatics (public health informatics), information sciences, computer science, biostatistics, mathematics, management sciences, health communication, sociology, and other similar disciplines. Few jurisdictions have invested in exploring these interdisciplinary perspectives. The United Kingdom’s National Health Service initiated the Graduate Management Training Scheme for health systems leaders with a health informatics specialization [45]. The Australasian Institute of Digital Health notes similar interdisciplinary capacity-building efforts are needed to prepare the health workforce to address the impacts of digital technologies [45,47]. While these efforts have been within the broader field of digital health, similar interdisciplinary training efforts are required to translate the leadership competency recommendations identified in this study.

To the best of our knowledge, this rapid review represents the first review of evidence on digital competency and training recommendations specifically for public health. While we have used the framework of the core competencies as developed in Canada by the PHAC to situate the training recommendations, these competencies and training recommendations have implications not just in Canada, but across other jurisdictions. First, there is a critical evidence gap that must be filled concerning digital competencies for public health even within the broader digital health discourse [48,49]. Our findings highlight current recommendations while demonstrating the relative inattention to the unique competencies required for the digital transformation of public health practice. Second, this review highlights the need for generalized orientation of public health practitioners to digital technologies, while creating opportunities for specialized digital competencies, especially through practice-based learning. Such approaches will enhance deeper understanding of the challenges these technologies pose, while contextualizing jurisdictional policies relevant to the ethical and just use of these technologies, especially the use of large digital data sets pulling health information from various sources; designing, implementing, and evaluating people-centered digital innovations in public health; using social media for targeted communication; providing leadership in managing digital technologies for public health; and communicating the need for these tools with the public and relevant partners [6]. Third, this review highlights the need to deeply integrate interdisciplinarity in the public health curriculum. This imperative will not only allow public health practitioners to adequately use digital technologies for their functions but prepare them to respond to digital technologies as a superdeterminant of health [9]. For example, the World Health Organization has suggested competency frameworks for managing infodemics—the spread of misinformation and disinformation, which is amplified by widespread access to unverified information online [50]. There are also advantages of strengthening interdisciplinary digital public health curricula, as these could have multiplier effects in building public capacity given the role public health practitioners play in educating the public on health threats—including mis- and disinformation.

Fourth, this review also identified digital competencies and gaps requiring additional research and training approaches that leverage interdisciplinarity. We described competencies not specific to, but related to, digital technologies in public health that mostly reflect attitudinal changes required of the workforce to effectively leverage digital technologies and respond to future technological changes. For example, there are recommendations for additional social, emotional, and cognitive competencies, including curiosity, innovation, willingness to make mistakes but learn from them, and interdisciplinarity—a paradigm well aligned with human-centered approaches to developing digital technologies more broadly but currently at odds with public health’s risk-averse stance [51,52]. Finally, beyond research on new digital competencies from a public health perspective, additional research is needed to effectively integrate identified recommendations into current competency frameworks. Such research must consider components of generalized curricular updates to help practitioners understand the digital landscape while creating space for specialized training programs for specific public health roles [44]. Most existing competency frameworks promote a tiered approach, where frontline workers with digital technologies have more specific training compared with those in management positions, who require a basic understanding of how the digital technologies work [18]. Given escalating demands for new competencies across various domains of public health, the challenge will be to holistically integrate these digital practices in existing curricula as opposed to simply attaching new courses. Specific attention will be required to address the newly identified competency category to ensure that principles of health equity and ethical propriety are upheld throughout the competencies. While our research aims to contribute to closing this knowledge gap, other similar research is ongoing (at the time of writing) in other jurisdictions, including updates to health management competencies for digital transformation in Australasia. However, a perspective lacking in these efforts involves mechanisms for ongoing and nimbler competency and curricular evaluations and updates, given the speed of evolution of digital technologies and the scope of their impacts on public health. Such mechanisms could involve a standing competency development committee with mandates for regular (perhaps yearly) minor updates, with larger updates requiring broad consultations considered on a longer timeframe. As a next step in our multiphase research, we are validating identified competency recommendations with public health practitioners through focus groups to ensure they are well adapted to the Canadian context while understanding the implications of such nimble update systems for their practices [14].

Strengths and Limitations

This report represents a first attempt at synthesizing competency and training recommendations for improving the public health workforce’s capacity to effectively use digital technologies. Our exploration of competencies related to digital technologies specifically within public health is bolstered by our approach to identifying training recommendations and disciplinary approaches to achieve identified competencies. The rapid review methodology was used for pragmatic reasons because we intended to develop recommendations to inform focus groups in a larger project in Canada to ensure our academic and public health practice partners and knowledge users could consider updates to the curriculum. The Cochrane rapid review methodology recommends that 2 reviewers should perform dual screening of at least 20% of abstracts during title and abstract screening and perform a single review of full texts [20]. To ensure rigor, we dual-screened 25% of titles and abstracts and dual-screened all full texts (above recommended levels). We also searched multiple databases in line with recommendations, ensuring comprehensiveness of the review [53]. However, our rapid review is unlikely to have exhaustively characterized the research area, given our need for expedient delivery of evidence. Given the search strategy and inclusion criteria specifically identified publications discussing digital competencies and training approaches related to the role of digital technologies in executing a broad range of public health functions, we may have inadvertently excluded relevant competency recommendations made solely in the clinical context or within the broader context of digital health. Additionally, articles describing training in passing were not included, and this may have limited the breadth of digital competency recommendations identified. To ensure feasibility, we only included publications in English, and the review could have missed important non-English resources. Our broad approach and definitions of terms like “digital technologies in public health” may have also missed the depth of discussions within specific domains of public health. Finally, the timing of our search may have missed additional perspectives on digital competencies, given known publication lags and a refocus on better public health preparedness toward the end of the COVID-19 pandemic [54]. This is plausible given our findings of heightened awareness of digital competency gaps and extended periods required to update competency recommendations. Our recommendations for nimbler mechanisms for developing and updating competencies may address this issue.

Conclusion

To adequately support the digital transformation of public health, practitioners require new digital competencies cutting across and extending existing public health competency frameworks, particularly in Canada. However, the literature is currently sparse regarding what these competencies are and what training approaches might facilitate the competencies. Therefore, research in this area is crucially needed alongside developing mechanisms for competency updates that attempt to keep pace with the development of digital technologies in public health. Where available, evidence suggests the workforce requires new competencies that cut across and extend existing categories of public health competency frameworks, including new competencies related to the use and protection of new digital data sources, alongside facilitating health communication and promotion functions using digital media. Recommendations also emphasize the need for training approaches that focus on interdisciplinarity and innovation through adapted degree-awarding public health training programs and ongoing professional development. As a next step, we are validating identified competency recommendations with public health practitioners to ensure they are well adapted to the Canadian context through focus group discussions with the Canadian public health workforce.